Double nerve transfer for elbow flexion in obstetric brachial plexus injury: A case report

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2013-03, Vol.66 (3), p.423-426
• Main Authors: Estrella, Emmanuel P, Mella, Pierre M
• Format: Article
• Language: English
• Subjects: Birth Injuries - complications; Birth Injuries - surgery; Brachial Plexus Neuropathies - etiology; Brachial Plexus Neuropathies - surgery; Double nerve transfer; Elbow Joint - physiopathology; Elbow Joint - surgery; Follow-Up Studies; Humans; Infant; Male; Median Nerve - surgery; Median Nerve - transplantation; Nerve transfer; Nerve Transfer - methods; Obstetric palsy; Plastic Surgery; Range of Motion, Articular - physiology; Recovery of Function; Risk Assessment; Time Factors; Treatment Outcome; Ulnar Nerve - surgery; Ulnar Nerve - transplantation
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2012.06.012

Summary We report a case of a 10-month-old boy with a left extended upper type (C5–C7) obstetric brachial plexus injury that was treated with double nerve transfer (partial ulnar and partial median nerve transfer) to restore elbow flexion and spinal accessory nerve transfer to the suprascapular nerve to restore shoulder abduction. At 60 months' follow-up, shoulder abduction was 0–150° (M4) and elbow flexion was 0–140° (M5). Elbow, wrist and finger extension improved to M5. However, shoulder external rotation was only 0–30° (from full internal rotation). No weakness on finger and wrist flexion was observed. Double nerve transfers to restore elbow flexion can be safely done in obstetric brachial plexus injuries with good results. Secondary surgeries may be needed to improve external rotation.